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流行性脑脊髓膜炎 epidemic cerebrospinal meningitis

流行性脑脊髓膜炎 epidemic cerebrospinal meningitis. 概述 病原学 脑膜炎奈瑟菌 内毒素 是其重要的致病因素 可产生 自溶酶 分 13 群： A B C D 29E H I K W135 X Y Z. 流脑病人脑脊液革兰染色可见成双排列的革兰阴性双球菌。. 流行病学 （一）传染源：病人 带菌者 （二）传播途径：呼吸道飞沫 （三）人群易感性：儿童发病率高 （四）流行特征：冬春季多发 周期性流行. 隐性感染. 带菌者. 细菌 鼻咽部. 皮肤淤点. 菌血症.

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流行性脑脊髓膜炎 epidemic cerebrospinal meningitis

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  1. 流行性脑脊髓膜炎 epidemic cerebrospinal meningitis

  2. 概述 病原学 脑膜炎奈瑟菌 内毒素是其重要的致病因素 可产生自溶酶 分13群：A BC D 29E H I K W135X YZ

  3. 流脑病人脑脊液革兰染色可见成双排列的革兰阴性双球菌。流脑病人脑脊液革兰染色可见成双排列的革兰阴性双球菌。

  4. 流行病学 （一）传染源：病人 带菌者 （二）传播途径：呼吸道飞沫 （三）人群易感性：儿童发病率高 （四）流行特征：冬春季多发 周期性流行

  5. 隐性感染 带菌者 细菌 鼻咽部 皮肤淤点 菌血症 败血症 发热等 脑脊髓膜化脓性炎症 发病机制

  6. 细菌 皮肤粘膜血管内皮细胞内繁殖 ● 释放内毒素 引起出血坏死（淤点 淤斑） 大量内毒素 全身小血管痉挛 微循环障碍 ● 有效循环血量减少（感染性休克） 血流缓慢 血细胞凝聚 加上血管内皮细胞损伤 组织损伤 激活凝血系统 DIC 加重微循环障碍 出血 MOF 败血症期

  7. 脑膜脊髓膜血管内皮细胞坏死 血管通透性增加 血浆外渗 水肿 重者脑实质亦有炎症 内毒素 脑微循环障碍 缺氧 水肿 出血 昏迷 抽搐 脑疝 脑膜炎期

  8. 临床表现 （一）普通型 1、前驱期（上呼吸道感染期） 2、败血症期 3、脑膜炎期 4、恢复期

  9. （二）暴发型 1、休克型 fulminant meningococcal septicemia acute respiratory distress syndrome 2、脑膜脑炎型 3、混合型 （三）轻型 （四）慢性脑膜炎双球菌败血症

  10. 实验室检查 （一）血象 WBC升高 （10～20）×109/L （二）CSF （三）细菌学检查 1、凃片 2、培养 （四）免疫学检查 特异性抗原、抗体

  11. 诊断 1、流行病学资料 2、临床表现 3、实验室检查

  12. 鉴别诊断 1、其他病原体引起的中枢神经系统感染 （1）其他细菌引起的化脓性脑膜炎 肺炎链球菌streptococcus pneumoniae 流感嗜血杆菌haemophilus influenzae 金黄色葡萄球菌staphylococcus aureus （2）结核性脑膜炎 （3）流行性乙型脑炎 2、其他病原菌引起的败血症休克

  13. 治疗 （一）普通型的治疗 1、一般治疗 2、病原治疗 青霉素G 首选 磺胺嘧啶 氯霉素 三代头孢菌素 3、对症治疗

  14. （二）暴发型的治疗 1、休克型的治疗 抗菌药 纠正休克 肾上腺皮质激素 DIC治疗 保护重要脏器功能 2、脑膜脑炎型的治疗 抗菌药 防治脑水肿、脑疝、呼吸衰竭 肾上腺皮质激素

  15. 预防 （一）管理传染源 （二）切断传播途径 （三）提高人群免疫力 A群多糖菌苗 双价菌苗 四价菌苗

  16. Meningococcal Infections Meningococcal infections are a major cause of mortality and morbidity in developed and developing nations. Neisseria meningitidis is the causative agent in meningococcal infections. It has become the most common cause of bacterial meningitis in American children since the use of the Haemophilus influenzae type b protein-capsular polysaccharide conjugate vaccine in infants dramatically reduced their incidence of meningitis due to this organism. Considerable progress has been made in the management and prevention of infections due to Neisseria meningitidis since the organism was first described in 1887. Because the meningococcal vaccine has limited effectiveness in the group at greatest risk to infection,

  17. children younger than the age of 2, meningococcal infection is still a major worldwide problem. The devastating nature of systemic meningococcal infection makes it imperative that preventive measures be developed to fully control this disease. In addition, an effective vaccine against meningococcal serogroup B infection has not been developed. Until this goal is realized, it is crucial that the clinician recognize and be able to successfully treat the infection as early as possible in its course to ensure an outcome with minimum mortality and morbidity.

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